|
PR OPH SVCS MEDICAL XM&EVAL INTERMEDIATE EST PT
|
Professional
|
Both
|
$202.37
|
|
|
Service Code
|
HCPCS 92012
|
| Min. Negotiated Rate |
$30.30 |
| Max. Negotiated Rate |
$121.77 |
| Rate for Payer: Amida Care Medicaid |
$30.30
|
| Rate for Payer: Cash Price |
$54.79
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$54.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$48.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$48.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$51.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$54.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$51.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$54.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$54.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$40.59
|
| Rate for Payer: Healthfirst Commercial |
$54.12
|
| Rate for Payer: Healthfirst Essential Plan |
$121.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$51.41
|
| Rate for Payer: Healthfirst QHP |
$54.12
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$37.88
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$54.12
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$46.00
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$37.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$54.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$40.59
|
| Rate for Payer: SOMOS Essential |
$40.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$54.12
|
|
|
PR OPHTHALMIC MUCOUS MEMBRANE TESTS
|
Professional
|
Both
|
$162.30
|
|
|
Service Code
|
HCPCS 95060
|
| Min. Negotiated Rate |
$11.56 |
| Max. Negotiated Rate |
$104.44 |
| Rate for Payer: Amida Care Medicaid |
$11.56
|
| Rate for Payer: Cash Price |
$46.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$46.42
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$41.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$41.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$44.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$46.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$44.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$46.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$46.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$34.81
|
| Rate for Payer: Healthfirst Commercial |
$46.42
|
| Rate for Payer: Healthfirst Essential Plan |
$104.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$44.10
|
| Rate for Payer: Healthfirst QHP |
$46.42
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$32.49
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$46.42
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$39.46
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$32.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$46.42
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$34.81
|
| Rate for Payer: SOMOS Essential |
$34.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$46.42
|
|
|
PR OPHTHALMODYNAMOMETRY
|
Professional
|
Both
|
$42.18
|
|
|
Service Code
|
HCPCS 92260
|
| Min. Negotiated Rate |
$8.25 |
| Max. Negotiated Rate |
$26.50 |
| Rate for Payer: Amida Care Medicaid |
$25.25
|
| Rate for Payer: Cash Price |
$11.92
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$11.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$11.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.84
|
| Rate for Payer: Healthfirst Commercial |
$11.78
|
| Rate for Payer: Healthfirst Essential Plan |
$26.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11.19
|
| Rate for Payer: Healthfirst QHP |
$11.78
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$8.25
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$11.78
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$10.01
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$8.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$11.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$8.84
|
| Rate for Payer: SOMOS Essential |
$8.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.78
|
|
|
PR OPN AXILLARY/SUBCLAVIAN ART EXPOS W/CNDT CRTJ
|
Professional
|
Both
|
$1,643.53
|
|
|
Service Code
|
HCPCS 34716
|
| Min. Negotiated Rate |
$302.42 |
| Max. Negotiated Rate |
$972.07 |
| Rate for Payer: Cash Price |
$435.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$432.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$388.83
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$388.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$410.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$432.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$410.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$432.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$432.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$324.02
|
| Rate for Payer: Healthfirst Commercial |
$432.03
|
| Rate for Payer: Healthfirst Essential Plan |
$972.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$410.43
|
| Rate for Payer: Healthfirst QHP |
$432.03
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$302.42
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$432.03
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$367.23
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$302.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$432.03
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$324.02
|
| Rate for Payer: SOMOS Essential |
$324.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$432.03
|
|
|
PR OPN AX/SUBCLA ART EXPOS DLVR EVASC PROSTH UNI
|
Professional
|
Both
|
$1,330.81
|
|
|
Service Code
|
HCPCS 34715
|
| Min. Negotiated Rate |
$241.98 |
| Max. Negotiated Rate |
$777.80 |
| Rate for Payer: Cash Price |
$350.41
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$345.69
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$311.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$311.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$328.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$345.69
|
| Rate for Payer: Fidelis Qualified Health Plan |
$328.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$345.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$345.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$259.27
|
| Rate for Payer: Healthfirst Commercial |
$345.69
|
| Rate for Payer: Healthfirst Essential Plan |
$777.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$328.41
|
| Rate for Payer: Healthfirst QHP |
$345.69
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$241.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$345.69
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$293.84
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$241.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$345.69
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$259.27
|
| Rate for Payer: SOMOS Essential |
$259.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$345.69
|
|
|
PR OPN BRACHIAL ARTERY EXPOS DLVR EVASC PROSTH UNI
|
Professional
|
Both
|
$577.33
|
|
|
Service Code
|
HCPCS 34834
|
| Min. Negotiated Rate |
$104.64 |
| Max. Negotiated Rate |
$336.33 |
| Rate for Payer: Cash Price |
$151.79
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$149.48
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$134.53
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$134.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$142.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$149.48
|
| Rate for Payer: Fidelis Qualified Health Plan |
$142.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$149.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$149.48
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$112.11
|
| Rate for Payer: Healthfirst Commercial |
$149.48
|
| Rate for Payer: Healthfirst Essential Plan |
$336.33
|
| Rate for Payer: Healthfirst Medicare Advantage |
$142.01
|
| Rate for Payer: Healthfirst QHP |
$149.48
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$104.64
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$149.48
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$127.06
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$104.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$149.48
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$112.11
|
| Rate for Payer: SOMOS Essential |
$112.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$149.48
|
|
|
PR OPN FEM ART EXPOS DLVR EVASC PROSTH UNI
|
Professional
|
Both
|
$911.93
|
|
|
Service Code
|
HCPCS 34812
|
| Min. Negotiated Rate |
$167.10 |
| Max. Negotiated Rate |
$537.10 |
| Rate for Payer: Cash Price |
$241.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$238.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$214.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$214.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$226.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$238.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$226.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$238.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$238.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$179.03
|
| Rate for Payer: Healthfirst Commercial |
$238.71
|
| Rate for Payer: Healthfirst Essential Plan |
$537.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$226.77
|
| Rate for Payer: Healthfirst QHP |
$238.71
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$167.10
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$238.71
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$202.90
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$167.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$238.71
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$179.03
|
| Rate for Payer: SOMOS Essential |
$179.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$238.71
|
|
|
PR OPN FEM ART EXPOS W/CNDT CRTJ DLVR EVASC PROSTH
|
Professional
|
Both
|
$1,192.35
|
|
|
Service Code
|
HCPCS 34714
|
| Min. Negotiated Rate |
$218.62 |
| Max. Negotiated Rate |
$702.70 |
| Rate for Payer: Cash Price |
$315.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$312.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$281.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$281.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$296.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$312.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$296.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$312.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$312.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$234.23
|
| Rate for Payer: Healthfirst Commercial |
$312.31
|
| Rate for Payer: Healthfirst Essential Plan |
$702.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$296.69
|
| Rate for Payer: Healthfirst QHP |
$312.31
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$218.62
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$312.31
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$265.46
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$218.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$312.31
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$234.23
|
| Rate for Payer: SOMOS Essential |
$234.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$312.31
|
|
|
PR OPN ILIAC ART EXPOS CRTJ PROSTH EST CARD BYP
|
Professional
|
Both
|
$1,745.07
|
|
|
Service Code
|
HCPCS 34833
|
| Min. Negotiated Rate |
$319.18 |
| Max. Negotiated Rate |
$1,025.93 |
| Rate for Payer: Cash Price |
$461.49
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$455.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$410.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$410.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$433.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$455.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$433.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$455.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$455.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$341.98
|
| Rate for Payer: Healthfirst Commercial |
$455.97
|
| Rate for Payer: Healthfirst Essential Plan |
$1,025.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$433.17
|
| Rate for Payer: Healthfirst QHP |
$455.97
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$319.18
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$455.97
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$387.57
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$319.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$455.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$341.98
|
| Rate for Payer: SOMOS Essential |
$341.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$455.97
|
|
|
PR OPN ILIAC ART EXPOS PROSTH/ILIAC OCCLS EVASC UNI
|
Professional
|
Both
|
$1,497.27
|
|
|
Service Code
|
HCPCS 34820
|
| Min. Negotiated Rate |
$273.93 |
| Max. Negotiated Rate |
$880.49 |
| Rate for Payer: Cash Price |
$395.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$391.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$352.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$352.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$371.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$391.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$371.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$391.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$391.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$293.50
|
| Rate for Payer: Healthfirst Commercial |
$391.33
|
| Rate for Payer: Healthfirst Essential Plan |
$880.49
|
| Rate for Payer: Healthfirst Medicare Advantage |
$371.76
|
| Rate for Payer: Healthfirst QHP |
$391.33
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$273.93
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$391.33
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$332.63
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$273.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$391.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$293.50
|
| Rate for Payer: SOMOS Essential |
$293.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$391.33
|
|
|
PR OPN RPR ARYSM RPR ARTL TRAUMA TUBE PROSTH
|
Professional
|
Both
|
$7,844.41
|
|
|
Service Code
|
HCPCS 34830
|
| Min. Negotiated Rate |
$1,436.63 |
| Max. Negotiated Rate |
$4,617.74 |
| Rate for Payer: Cash Price |
$2,076.43
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,052.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,847.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,847.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,949.71
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,052.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,949.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,052.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,052.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,539.25
|
| Rate for Payer: Healthfirst Commercial |
$2,052.33
|
| Rate for Payer: Healthfirst Essential Plan |
$4,617.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,949.71
|
| Rate for Payer: Healthfirst QHP |
$2,052.33
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,436.63
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,052.33
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,744.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,436.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,052.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,539.25
|
| Rate for Payer: SOMOS Essential |
$1,539.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,052.33
|
|
|
PR OPN RPR ARYSM RPR ARTL TRMA AORTO-BIFEM PROSTH
|
Professional
|
Both
|
$8,431.26
|
|
|
Service Code
|
HCPCS 34832
|
| Min. Negotiated Rate |
$1,545.19 |
| Max. Negotiated Rate |
$4,966.67 |
| Rate for Payer: Cash Price |
$2,232.40
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,207.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,986.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,986.67
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,097.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,207.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,097.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,207.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,207.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,655.56
|
| Rate for Payer: Healthfirst Commercial |
$2,207.41
|
| Rate for Payer: Healthfirst Essential Plan |
$4,966.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,097.04
|
| Rate for Payer: Healthfirst QHP |
$2,207.41
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,545.19
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,207.41
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,876.30
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,545.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,207.41
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,655.56
|
| Rate for Payer: SOMOS Essential |
$1,655.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,207.41
|
|
|
PR OPN RPR ARYSM RPR ARTL TRMA AORTOBIILIAC PROSTH
|
Professional
|
Both
|
$8,569.26
|
|
|
Service Code
|
HCPCS 34831
|
| Min. Negotiated Rate |
$1,576.16 |
| Max. Negotiated Rate |
$5,066.23 |
| Rate for Payer: Cash Price |
$2,270.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,251.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,026.49
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,026.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,139.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,251.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,139.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,251.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,251.66
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,688.74
|
| Rate for Payer: Healthfirst Commercial |
$2,251.66
|
| Rate for Payer: Healthfirst Essential Plan |
$5,066.23
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,139.08
|
| Rate for Payer: Healthfirst QHP |
$2,251.66
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,576.16
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,251.66
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,913.91
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,576.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,251.66
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,688.74
|
| Rate for Payer: SOMOS Essential |
$1,688.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,251.66
|
|
|
PR OPN SUBCLA CRTD ART TRPOS NCK INC ULAT
|
Professional
|
Both
|
$3,529.23
|
|
|
Service Code
|
HCPCS 33889
|
| Min. Negotiated Rate |
$648.46 |
| Max. Negotiated Rate |
$2,084.33 |
| Rate for Payer: Cash Price |
$933.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$926.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$833.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$833.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$880.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$926.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$880.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$926.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$926.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$694.78
|
| Rate for Payer: Healthfirst Commercial |
$926.37
|
| Rate for Payer: Healthfirst Essential Plan |
$2,084.33
|
| Rate for Payer: Healthfirst Medicare Advantage |
$880.05
|
| Rate for Payer: Healthfirst QHP |
$926.37
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$648.46
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$926.37
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$787.41
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$648.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$926.37
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$694.78
|
| Rate for Payer: SOMOS Essential |
$694.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$926.37
|
|
|
PROPOFOL 1000 MG/100ML IV EMUL
|
Facility
|
OP
|
$0.36
|
|
|
Service Code
|
HCPCS J2704
|
| Hospital Charge Code |
6332326965
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.29 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.13
|
| Rate for Payer: Aetna Government |
$0.13
|
| Rate for Payer: Brighton Health Commercial |
$0.27
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.29
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.24
|
| Rate for Payer: EmblemHealth Commercial |
$0.18
|
| Rate for Payer: Group Health Inc Commercial |
$0.18
|
| Rate for Payer: Group Health Inc Medicare |
$0.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.23
|
|
|
PROPOFOL 1000 MG/100ML IV EMUL
|
Facility
|
IP
|
$0.36
|
|
|
Service Code
|
HCPCS J2704
|
| Hospital Charge Code |
6332326965
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.18 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.18
|
|
|
PROPOFOL 1000 MG/100ML IV EMUL
|
Facility
|
IP
|
$0.14
|
|
|
Service Code
|
HCPCS J2704
|
| Hospital Charge Code |
6332326969
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.07
|
|
|
PROPOFOL 1000 MG/100ML IV EMUL
|
Facility
|
OP
|
$0.14
|
|
|
Service Code
|
HCPCS J2704
|
| Hospital Charge Code |
6332326969
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.13 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.08
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.13
|
| Rate for Payer: Aetna Government |
$0.13
|
| Rate for Payer: Brighton Health Commercial |
$0.11
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.10
|
| Rate for Payer: EmblemHealth Commercial |
$0.07
|
| Rate for Payer: Group Health Inc Commercial |
$0.07
|
| Rate for Payer: Group Health Inc Medicare |
$0.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.09
|
|
|
PROPOFOL 10 MG/ML IV INJECTION (WRAPPED)
|
Facility
|
IP
|
$0.36
|
|
|
Service Code
|
HCPCS J2704
|
| Hospital Charge Code |
6332326929
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.18 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.18
|
|
|
PROPOFOL 10 MG/ML IV INJECTION (WRAPPED)
|
Facility
|
OP
|
$0.36
|
|
|
Service Code
|
HCPCS J2704
|
| Hospital Charge Code |
6332326929
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.29 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.13
|
| Rate for Payer: Aetna Government |
$0.13
|
| Rate for Payer: Brighton Health Commercial |
$0.27
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.29
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.24
|
| Rate for Payer: EmblemHealth Commercial |
$0.18
|
| Rate for Payer: Group Health Inc Commercial |
$0.18
|
| Rate for Payer: Group Health Inc Medicare |
$0.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.23
|
|
|
PROPOFOL 200 MG/20ML IV EMUL
|
Facility
|
IP
|
$0.09
|
|
|
Service Code
|
HCPCS J2704
|
| Hospital Charge Code |
8083011881
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.04
|
|
|
PROPOFOL 200 MG/20ML IV EMUL
|
Facility
|
OP
|
$0.36
|
|
|
Service Code
|
HCPCS J2704
|
| Hospital Charge Code |
6332326922
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.29 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.13
|
| Rate for Payer: Aetna Government |
$0.13
|
| Rate for Payer: Brighton Health Commercial |
$0.27
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.29
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.24
|
| Rate for Payer: EmblemHealth Commercial |
$0.18
|
| Rate for Payer: Group Health Inc Commercial |
$0.18
|
| Rate for Payer: Group Health Inc Medicare |
$0.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.23
|
|
|
PROPOFOL 200 MG/20ML IV EMUL
|
Facility
|
OP
|
$0.09
|
|
|
Service Code
|
HCPCS J2704
|
| Hospital Charge Code |
8083011881
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.13 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.13
|
| Rate for Payer: Aetna Government |
$0.13
|
| Rate for Payer: Brighton Health Commercial |
$0.07
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.07
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.06
|
| Rate for Payer: EmblemHealth Commercial |
$0.04
|
| Rate for Payer: Group Health Inc Commercial |
$0.04
|
| Rate for Payer: Group Health Inc Medicare |
$0.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.06
|
|
|
PROPOFOL 200 MG/20ML IV EMUL
|
Facility
|
OP
|
$0.14
|
|
|
Service Code
|
HCPCS J2704
|
| Hospital Charge Code |
6332326994
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.13 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.08
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.13
|
| Rate for Payer: Aetna Government |
$0.13
|
| Rate for Payer: Brighton Health Commercial |
$0.11
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.10
|
| Rate for Payer: EmblemHealth Commercial |
$0.07
|
| Rate for Payer: Group Health Inc Commercial |
$0.07
|
| Rate for Payer: Group Health Inc Medicare |
$0.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.09
|
|
|
PROPOFOL 200 MG/20ML IV EMUL
|
Facility
|
IP
|
$0.36
|
|
|
Service Code
|
HCPCS J2704
|
| Hospital Charge Code |
6332326922
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.18 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.18
|
|
